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ObjectId: 201921349349301097 - Submission: 2019-05-14
TIN: 36-3166895
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
Attach to Form 990.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
17
Open to Public Inspection
Name of the organization
Sinai Health System
Employer identification number
36-3166895
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
First-class or charter travel
Housing allowance or residence for personal use
Travel for companions
Payments for business use of personal residence
Tax idemnification and gross-up payments
Health or social club dues or initiation fees
Discretionary spending account
Personal services (e.g., maid, chauffeur, chef)
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain
.........
1b
Yes
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a?
..
2
Yes
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
Compensation committee
Written employment contract
Independent compensation consultant
Compensation survey or study
Form 990 of other organizations
Approval by the board or compensation committee
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment?
.............
4a
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan?
.........
4b
Yes
c
Participate in, or receive payment from, an equity-based compensation arrangement?
.........
4c
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization?
....................
5a
No
b
Any related organization?
.......................
5b
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization?
..................
6a
No
b
Any related organization?
......................
6b
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III
............
7
No
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III
..........................
8
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)?
.........................
9
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2017
Page 2
Schedule J (Form 990) 2017
Page
2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees.
Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note.
The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A)
Name and Title
(B)
Breakdown of W-2 and/or 1099-MISC compensation
(C)
Retirement and other deferred compensation
(D)
Nontaxable
benefits
(E)
Total of columns
(B)(i)-(D)
(F)
Compensation in column (B) reported as deferred on prior Form 990
(i)
Base
compensation
(ii)
Bonus & incentive
compensation
(iii)
Other
reportable compensation
1
Bakul Patel
CHIEF INF OFFCR UNTIL 6/29/18
(i)
(ii)
0
-------------
300,470
0
-------------
16,270
0
-------------
2,643
0
-------------
5,400
0
-------------
0
0
-------------
324,783
0
-------------
0
2
Brent Spyrka
Systems Director - Info Sys
(i)
(ii)
137,593
-------------
0
4,290
-------------
0
3,932
-------------
0
2,909
-------------
0
18,923
-------------
0
167,647
-------------
0
0
-------------
0
3
Charles Weis Jr
EXEC.VP ADM/CFO UNTIL 12/31/17
(i)
(ii)
0
-------------
468,379
0
-------------
33,204
0
-------------
62,955
0
-------------
0
0
-------------
23,384
0
-------------
587,922
0
-------------
0
4
DANIEL KATZ MD
BD MBR/PHYSICIAN UNTIL 4/11/18
(i)
(ii)
0
-------------
445,330
0
-------------
0
0
-------------
437
0
-------------
0
0
-------------
0
0
-------------
445,767
0
-------------
26,403
5
Debra Wesley
President of Sinai Comm Inst
(i)
(ii)
0
-------------
231,108
0
-------------
27,922
0
-------------
76,264
0
-------------
5,400
0
-------------
24,120
0
-------------
364,814
0
-------------
0
6
Jason N Spigner
Chief Human Resources Officer
(i)
(ii)
0
-------------
237,835
0
-------------
0
0
-------------
12,482
0
-------------
0
0
-------------
7,088
0
-------------
257,405
0
-------------
0
7
Karen Teitelbaum
President & CEO
(i)
(ii)
0
-------------
755,327
0
-------------
58,680
0
-------------
82,055
0
-------------
5,400
0
-------------
8,505
0
-------------
909,967
0
-------------
0
8
Loren Chandler
CFO & COO
(i)
(ii)
0
-------------
440,517
0
-------------
39,540
0
-------------
14,964
0
-------------
5,400
0
-------------
28,652
0
-------------
529,073
0
-------------
0
9
Pablo Morales
Director of Information System
(i)
(ii)
142,143
-------------
0
2,867
-------------
0
454
-------------
0
1,494
-------------
0
18,527
-------------
0
165,485
-------------
0
0
-------------
0
10
Rachel Dvorken
Exec. VP & General Counsel
(i)
(ii)
0
-------------
303,600
0
-------------
26,484
0
-------------
47,309
0
-------------
5,400
0
-------------
0
0
-------------
382,793
0
-------------
0
11
Vikas A Shah
Technology Services System Dir
(i)
(ii)
132,222
-------------
0
4,529
-------------
0
1,506
-------------
0
2,816
-------------
0
20,085
-------------
0
161,158
-------------
0
0
-------------
0
Schedule J (Form 990) 2017
Page 3
Schedule J (Form 990) 2017
Page
3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference
Explanation
Schedule J, Part I, Question 1a
THE SINAI HEALTH SYSTEM, FOR BUSINESS PURPOSES IS A CORPORATE MEMBER OF THE STANDARD CLUB. THE MEMBERSHIP PROVIDED TO KAREN TEITELBAUM IS TREATED BY THE SINAI HEALTH SYSTEM AS A WORKING-CONDITION FRINGE BENEFIT AND IS, THEREFORE, EXCLUDED FROM THE INDIVIDUAL'S TAXABLE INCOME.
schedule j, PART I, LINE 3
METHODS USED TO DETERMINE CEO COMPENSATION SINAI HEALTH SYSTEM (SHS) HAS A HUMAN RESOURCES COMMITTEE TO SUPPORT THE ORGANIZATIONAL PERFORMANCE OF SINAI HEALTH SYSTEM AND ITS RELATED ENTITIES THROUGH THE ALIGNMENT OF EXECUTIVE COMPENSATION WITH SYSTEM STRATEGIES AND PROGRAMS AND ENSURE COMPLIANCE WITH APPLICABLE LAW. THE VOTING MEMBERS OF THE COMMITTEE ARE INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. THE COMMITTEE ESTABLISHES DETAILED GOALS ANNUALLY OR MORE FREQUENTLY AS CIRCUMSTANCES REQUIRE. THE COMMITTEE ESTABLISHES DETAILED GOALS ANNUALLY FOR THE PRESIDENT AND CEO AND OTHER EXECUTIVES, AND REVIEWS PERFORMANCE AGAINST THESE GOALS ON AN ANNUAL BASIS. THE COMMITTEE ANNUALLY ENGAGES AN OUTSIDE INDEPENDENT COMPENSATION CONSULTANT TO BENCHMARK THE SALARIES AND BENEFITS OF THE ORGANIZATION'S ASSISTANT VICE PRESIDENT AND ABOVE. COMPENSATION IS BASED ON: A) DETAILED WRITTEN PERFORMANCE OF THE PRESIDENT AND CEO; B) EACH ELEMENT OF COMPENSATION, DATA OF THE COMPENSATION PROGRAM IN EFFECT FOR CEOS OF COMPARABLE ORGANIZATIONS; AND C) ANNUAL REVIEW OF CEO PERFORMANCE IS CONDUCTED AGAINST SHS ESTABLISHED GOALS. THE COMMITTEE MAINTAINS WRITTEN MINUTES WHICH ARE MAINTAINED IN EXECUTIVE ADMINISTRATION.
schedule j, PART I, LINE 4B
SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN MOUNT SINAI HOSPITAL'S (MSH) SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WAS ESTABLISHED AS A NON-QUALIFIED RETIREMENT PLAN FOR ITS KEY EMPLOYEES, SPECIFICALLY THE CHIEF EXECUTIVE STAFF. THIS PLAN PROVIDES ADDED BENEFITS THAT MAY BE ABOVE AND BEYOND THOSE THRESHOLDS COVERED IN OTHER TRADITIONAL RETIREMENT PLANS. MSH'S SERP IS ENTIRELY FUNDED BY THE EMPLOYER, MSH. THE MSH COMPENSATION COMMITTEE REVIEWS AND APPROVES ACCEPTANCE AND/OR MODIFICATIONS TO THE SERP PLAN. THE MSH'S SERP PLAN OUTLINES THE ANNUAL EARNINGS PER THE INDIVIDUAL PARTICIPANTS AS WELL AS THE TIME FRAMES OF VESTMENT PER THOSE RESPECTIVE INDIVIDUALS. THE PLAN VESTS UPON TWO YEARS OF SERVICE OR ATTAINMENT OF AGE 65. INCREASE IN VALUE OF THE BENEFIT Not CY2017 PAYMENTS VESTED IN CY2017 CHANDLER, LOREN F $6,801 $1,051 DVORKEN, RACHEL $41,025 $1,628 WEIS JR, CHARLES $51,670 $2,058 TEITELBAUM, KAREN C $54,406 $2,294 WESLEY, DEBRA G $65,482 $866
Schedule j, PART I LINE 7
NON-FIXED PAYMENTS SINAI HEALTH SYSTEM HAS A HUMAN RESOURCES COMMITTEE TO SUPPORT THE ORGANIZATIONAL PERFORMANCE OF SINAI HEALTH SYSTEMS AND ITS RELATED ENTITIES THROUGH THE ALIGNMENT OF EXECUTIVE COMPENSATION WITH SYSTEM STRATEGIES AND PROGRAMS AND ENSURE COMPLIANCE WITH APPLICABLE LAW. THE VOTING MEMBERS OF THE COMMITTEE ARE INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. THE COMMITTEE ESTABLISHES DETAILED GOALS ANNUALLY OR MORE FREQUENTLY AS CIRCUMSTANCES REQUIRE. THE COMMITTEE ESTABLISHES DETAILED GOALS ANNUALLY FOR THE PRESIDENT AND CEO AND OTHER EXECUTIVES, AND REVIEWS PERFORMANCE AGAINST THESE GOALS ON AN ANNUAL BASIS. THE COMMITTEE ANNUALLY ENGAGES AN OUTSIDE INDEPENDENT COMPENSATION CONSULTANT TO BENCHMARK THE SALARIES AND BENEFITS OF THE ORGANIZATION'S ASSISTANT VICE PRESIDENT AND ABOVE. COMPENSATION IS BASED ON DETAILED WRITTEN PERFORMANCE OF THE PRESIDENT AND CEO, EACH ELEMENT OF COMPENSATION, DATA OF COMPENSATION PROGRAM IN EFFECT FOR CEOS OF COMPARABLE ORGANIZATIONS, AND CONDUCTS AN ANNUAL REVIEW OF CEO PERFORMANCE AGAINST ESTABLISHED GOALS. THE COMMITTEE MAINTAINS WRITTEN MINUTES WHICH ARE MAINTAINED IN EXECUTIVE ADMINISTRATION.
Schedule J (Form 990) 2017
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